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Sohail AH, Hakmi H, Cohen K, Hurwitz JC, Brite J, Cimaroli S, Tsou H, Khalife M, Maurer J, Symer M. Predictors of in-hospital appendiceal perforation in patients with non- perforated acute appendicitis with appendicolithiasis at presentation. BMC Surg 2023; 23:317. [PMID: 37853433 PMCID: PMC10585917 DOI: 10.1186/s12893-023-02210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Appendicolithiasis is a risk factor for perforated acute appendicitis. There is limited inpatient data on predictors of progression in appendicolithiasis-associated non-perforated acute appendicitis. METHODS We identified adults presenting with appendicolithiasis-associated non-perforated acute appendicitis (on computed tomography) who underwent appendectomy. Logistic regression was used to investigate predictors of in-hospital perforation (on histopathology). RESULTS 296 patients with appendicolithiasis-associated non-perforated acute appendicitis were identified; 48 (16.2%) had perforation on histopathology. Mean (standard deviation [SD]) age was 39 (14.9) years. The mean (SD) length of stay (LOS) was 1.5 (1.8) days. LOS was significantly longer with perforated (mean [SD]: 3.0 [3.1] days) vs. non-perforated (mean [SD]: 1.2 [1.2] days) appendicitis (p < 0.001). On multivariate analysis, in-hospital perforation was associated with age > 65 years (OR 5.4, 95% CI: 1.4- 22.2; p = 0.015), BMI > 30 kg/m2 (OR 3.5, 95% CI: 1.3-8.9; p = 0.011), hyponatremia (OR 3.6, 95% CI: 1.3-9.8; p = 0.012). There was no significant association with age 25-65 years, gender, race, steroids, time-to- surgery, neutrophil percentage, or leukocyte count. CONCLUSION Geriatric age, obesity, and hyponatremia are associated with progression to perforation in appendicolithiasis-associated non-perforated acute appendicitis.
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Affiliation(s)
- Amir H Sohail
- Department of Surgery, NYU Langone Long Island, 222 Station Plaza N. Suite 300, Mineola, NY, 11501, USA
| | - Hazim Hakmi
- Department of Surgery, NYU Langone Long Island, 222 Station Plaza N. Suite 300, Mineola, NY, 11501, USA
| | - Koral Cohen
- NYU Long Island School of Medicine, Mineola, NY, 11501, USA
| | | | - Jasmine Brite
- NYU Long Island School of Medicine, Mineola, NY, 11501, USA
| | - Sawyer Cimaroli
- Department of Surgery, NYU Langone Long Island, 222 Station Plaza N. Suite 300, Mineola, NY, 11501, USA.
| | - Harry Tsou
- Department of Surgery, NYU Langone Long Island, 222 Station Plaza N. Suite 300, Mineola, NY, 11501, USA
| | - Michael Khalife
- Department of Surgery, NYU Langone Long Island, 222 Station Plaza N. Suite 300, Mineola, NY, 11501, USA
| | - James Maurer
- Mount Sinai South Nassau Hospital Department of Surgery, Oceanside, NY, 11572, USA
| | - Matthew Symer
- Department of Surgery, NYU Langone Long Island, 222 Station Plaza N. Suite 300, Mineola, NY, 11501, USA
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Arredondo Montero J, Pérez Riveros BP, Bueso Asfura OE, Rico Jiménez M, López-Andrés N, Martín-Calvo N. Leucine-Rich Alpha-2-Glycoprotein as a non-invasive biomarker for pediatric acute appendicitis: a systematic review and meta-analysis. Eur J Pediatr 2023:10.1007/s00431-023-04978-2. [PMID: 37148275 DOI: 10.1007/s00431-023-04978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/21/2023] [Accepted: 04/09/2023] [Indexed: 05/08/2023]
Abstract
The aim of this study was to analyze the diagnostic performance of Leucine-Rich Alpha-2-Glycoprotein (LRG1) in pediatric acute appendicitis (PAA). We conducted a systematic review of the literature in the main databases of medical bibliography. Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of the results, standardization of the metrics and 4 random-effect meta-analyses were performed. Eight studies with data from 712 participants (305 patients with confirmed diagnosis of PAA and 407 controls) were included in this review. The random-effect meta-analysis of serum LRG1 (PAA vs control) resulted in a significant mean difference (95% CI) of 46.76 μg/mL (29.26-64.26). The random-effect meta-analysis for unadjusted urinary LRG1 (PAA vs control) resulted in a significant mean difference (95% CI) of 0.61 μg/mL (0.30-0.93). The random-effect meta-analysis (PAA vs control) for urinary LRG1 adjusted for urinary creatinine resulted in a significant mean difference (95% CI) of 0.89 g/mol (0.11-1.66). Conlusion: Urinary LRG1 emerges as a potential non-invasive biomarker for the diagnosis of PAA. On the other hand, due to the high between-study heterogeneity, the results on serum LRG1 should be interpreted with caution. The only study that analyzed salivary LRG1 showed promising results. Further prospective studies are needed to confirm these findings. What is Known: • Pediatric acute appendicitis continues to be a pathology with a high rate of diagnostic error. • Invasive tests, although useful, are a source of stress for patients and their parents. What is New: • LRG1 emerges as a promising urinary and salivary biomarker for the noninvasive diagnosis of pediatric acute appendicitis.
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Affiliation(s)
- Javier Arredondo Montero
- Department of Pediatric Surgery, Hospital Universitario de Navarra, 31008, Pamplona, Navarra, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.
| | - Blanca Paola Pérez Riveros
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - Oscar Emilio Bueso Asfura
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - María Rico Jiménez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - Natalia López-Andrés
- Cardiovascular Translational Research. NavarraBiomed (Miguel Servet Foundation), Hospital Universitario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Nerea Martín-Calvo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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Wu Z, Zhao L, Feng S, Luo J. Hyperfibrinogenemia and hyponatremia as predictors of perforated appendicitis in children: A retrospective cohort study. Int J Colorectal Dis 2023; 38:72. [PMID: 36930335 DOI: 10.1007/s00384-023-04362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The aim of this study was to investigate the predictive value of hyperfibrinogenemia and hyponatremia for perforated appendicitis in children. METHODS A retrospective review of 521 pediatric patients (≤ 15 years) with acute appendicitis confirmed by histopathology from January 2017 to December 2020 was performed. Patients were divided in two groups, those with non-perforated (n = 379; 73%) and perforated appendicitis (n = 142; 27%). The serum values of sodium and fibrinogen were taken before surgery. We performed the receiver operating characteristic analysis for the two biochemical markers. The sensitivity, specificity, positive and negative predictive values for perforated appendicitis in the presence of hyponatremia and hyperfibrinogenemia were calculated. RESULTS Hyperfibrinogenemia (≥ 4.0 g/L) was found in 58.45% of perforated appendicitis and 104 of 142 (73.34%) children with perforated appendicitis had hyponatremia (≤ 135 mmol/L). The perforated appendicitis group had a higher mean fibrinogen concentration (P = 0.001). There was a statistically significant difference in mean serum sodium levels between the perforated appendicitis and non-perforated appendicitis groups (P = 0.016). Receiver operating characteristic curve analysis for fibrinogen, sodium and combination of the both markers shown the combination had the largest area under the curve in identifying children with perforated acute appendicitis (0.858) (95% CI, 0.82-0.90) compared with fibrinogen (0.815) (95% CI, 0.77-0.86) and sodium 0.818 (95% CI, 0.78-0.86) alone. Furthermore, the combination of both markers had the best positive and negative predictive value for appendix perforation compared to fibrinogen and sodium. CONCLUSION Hyponatremia and/or hyperfibrinogenemia are excellent markers for predicting perforated appendicitis in children. We propose that plasma sodium and/or fibrinogen concentrations be utilized as a supplementary to guide individual treatment decisions in children with appendicitis, such as surgery timing and nonoperative management options.
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Affiliation(s)
- Zhenfei Wu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Jinjian Luo
- Department of Pulmonary and Critical Care Medicine (PCCM), Anji Branch of the First Affiliated Hospital of Zhejiang University, Anji County People's Hospital, Huzhou, Zhejiang, 313300, China.
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Sikander B, Rosenberg J, Fonnes S. Individual biomarkers in the blood are not yet applicable in diagnosing complicated appendicitis: A scoping review. Am J Emerg Med 2023; 67:100-107. [PMID: 36842426 DOI: 10.1016/j.ajem.2023.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Appendicitis is one of the most common surgical emergencies globally and it can both be difficult to diagnose but also to differentiate complicated from uncomplicated appendicitis preoperatively. The objective of this scoping review was to develop an overview of biomarkers in blood discriminating complicated from uncomplicated appendicitis and characterize their applicability in an acute setting including time, cost, and analysis technique required as well as their individual precision. METHOD This scoping review was reported in accordance with PRISMA-ScR. The included studies had to report on biomarkers measured in the blood for at least ten patients with suspected appendicitis. A systematic literature search was conducted on August 28, 2022, in PubMed and Embase but restricted to articles published in January 2000 and onwards. A protocol was uploaded to Open Science Framework prior to data extraction. RESULTS A total of 65 biomarkers were included from 52 studies, covering 14,312 patients. There was 60% routine- and 40% novel biomarkers based on the reported analysis technique. The most frequently investigated biomarkers within each group were white blood cell count and procalcitonin. The routine biomarkers were of low financial cost but poor diagnostic accuracy with sensitivity ranging between 15 and 100% and specificity between 27 and 100%. Novel markers were costly ranging from 275 to 800$, and their diagnostic accuracy was based on limited population sizes (median 34 patients) and reported for only 5% of the novel markers. CONCLUSION Routine biomarkers were applicable in an acute setting but had poor diagnostic accuracy. Novel biomarkers are being investigated for potential, but the concept is still premature due to lack of diagnostic accuracy studies reporting cost-benefit for individual markers and whether they can be applied in an acute setting.
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Affiliation(s)
- Binyamin Sikander
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark.
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark
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Wu Z, Zhao L, Liu Y, Qian S, Wu L, Liu X. Fibrinogen as a Marker of Overall and Complicated Acute Appendicitis: A Systematic Review and Meta-Analysis. J Surg Res 2022; 280:19-26. [PMID: 35944446 DOI: 10.1016/j.jss.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We performed a systematic review and meta-analysis to evaluate the diagnostic value of fibrinogen (FB) for acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis. METHODS A search of electronic information sources was conducted to identify all studies reporting FB in patients with clinical suspicion or confirmed diagnosis of acute appendicitis. We considered two comparisons: (1) appendicitis versus no appendicitis and (2) uncomplicated appendicitis versus complicated appendicitis. To assess the diagnostic value of FB, sensitivity, specificity, diagnostic odds ratios, summary receiver operating characteristic curves, area under the curve, and 95% confidence intervals (95% CIs) were estimated. RESULTS Seven studies (917 confirmed appendicitis and 1026 controls) for overall appendicitis and eight studies (602 complicated appendicitis and 1386 uncomplicated appendicitis) for complicated appendicitis were identified. The pooled sensitivity and specificity of FB for the diagnosis of appendicitis were 0.62 (95% CI: 0.58-0.65) and 0.79 (95% CI: 0.77-0.82), respectively. FB was more accurate in diagnosing complicated appendicitis, with a pooled sensitivity of 0.74 (95% CI: 0.69-0.78), specificity of 0.76 (95% CI: 0.73-0.78), and the area under the curve was 0.84. CONCLUSIONS As per this meta-analysis, FB has a potential diagnostic value in overall appendicitis and that it has a higher diagnostic value in the diagnosis of complicated appendicitis. Future well-designed prospective studies are needed to corroborate the findings.
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Affiliation(s)
- Zhenfei Wu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Lingling Zhao
- Department of Pathology, Zhejiang Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujun Liu
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuyang Qian
- Department of Pediatrics, Zhejiang Chinese Medical University, Hangzhou, China
| | - Liuqing Wu
- Department of Pediatrics, Hangzhou Normal University, Hangzhou, China
| | - Xian Liu
- Department of Critical Care Medicine, Anji County People's Hospital, Huzhou, Zhejiang Province, China.
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Zhou J, Xu W, Wang J, Fan Z. Related Markers for the Precision Diagnosis of Complex Appendicitis in Children. Front Pharmacol 2022; 13:865303. [PMID: 35431963 PMCID: PMC9010144 DOI: 10.3389/fphar.2022.865303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Acute appendicitis is the most common surgical emergency in children. Despite the high incidence rate of appendicitis, it is sometimes misdiagnosed or missed. Complex appendicitis (CA) in children is characterized by a critical condition, several complications, and high mortality. Precision distinguishing between simple appendicitis and CA correctly is key to choosing appropriate treatment. A safe, cheap, rapid, extensive and accurate diagnostic marker of appendicitis will be of great significance for emergency general surgeons to treat suspected CA. Many studies have investigated possible diagnostic markers for the diagnosis of CA in children. In this study, studies related to CA in children in recent years are summarized, and the related markers and scoring system for the diagnosis of CA in children are summarized.
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Affiliation(s)
- Jialin Zhou
- Department of General Surgery, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
- Department of Central Laboratory, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Wenjing Xu
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jitao Wang
- Department of Hepatobiliary Surgery, Xingtai People’s Hospital, Xingtai, China
- *Correspondence: Jitao Wang, ; Zhe Fan,
| | - Zhe Fan
- Department of General Surgery, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
- Department of Central Laboratory, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
- *Correspondence: Jitao Wang, ; Zhe Fan,
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Evaluation of plasma level of fibrinogen as a diagnostic criterion in acute appendicitis; cohort study. Ann Med Surg (Lond) 2022; 75:103393. [PMID: 35251602 PMCID: PMC8888974 DOI: 10.1016/j.amsu.2022.103393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Acute appendicitis (AA) is the most common etiology of abdominal operation worldwide. Despite advances in diagnostic guidelines there are still missed patients. This study evaluates assumption of plasma fibrinogen as a diagnostic criterion in AA. Method All patients over 12 years who were referred to emergency department and underwent index open appendectomy were enrolled in this cohort study. Histopathologically confirmed positive reports for presence of AA were allocated in a group. Controls experienced open appendectomy although pathological study was negative for AA. In addition to registering demographic data, plasma sample was examined for fibrinogen, quantitative C-reactive protein (CRP), and complete blood count preoperatively. Variables were compared. The ROC curve was customized and correlation coefficient for study markers was measured. Results Total 168 patients were enrolled. From all, 96 (57.1%) had confirmed AA, histopathologically. Gender, age, race, and body mass index had no difference between study groups (p > 0.05). In almost all patients increasing in white cell counts and left cellular shift was observed (p > 0.05). However, plasma level of fibrinogen and CRP reached to 389.2 ± 229.99 mg/dL (p = 0.001) and 33.06 ± 16.29 mg/L (p = 0.03) respectively, which both were significantly elevated in positive AA. Analysis showed area under the curve of serum fibrinogen was 0.892 (p < 0.001) with a cut-off point of 272 mg/dL had about 66.7% (95% CI:58.2–73.3) sensitivity, 92.8% (95% CI: 89.5–96.1) specificity, and 0.698 (p = 0.04) correlation coefficient for diagnosis of AA. Conclusion Amounts of elevated serum fibrinogen could imply on the diagnosis of AA specifically when concordance of clinical findings except for increasing CRP is unremarkable. Despite advances in diagnostic guides for acute appendicitis (AA), discordance between clinical and laboratory findings leads to doubtful diagnosis. Plasma fibrinogen elevates concurrently with C-reactive protein (CRP) in AA while has further specificity. Measurement of serum fibrinogen could when CRP is elevated and diagnosis of AA is in doubt.
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Kumar MSV, Tiwari MK, Singh J, Malik A. Plasma Fibrinogen: An Independent Predictor of Pediatric Appendicitis. J Indian Assoc Pediatr Surg 2021; 26:240-245. [PMID: 34385767 PMCID: PMC8323581 DOI: 10.4103/jiaps.jiaps_123_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/04/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Aims Appendicitis, in spite of all the diagnostic advances, achieving an accurate and timely diagnosis of this common condition in children remains a challenge. Plasma fibrinogen (FB) is an acute inflammatory mediator and has been proposed and evaluated as an adjunct laboratory marker for improving diagnostic accuracy. The study evaluates the plasma values of Se FB along with other serum markers in pediatric appendicitis patients, to determine their diagnostic accuracy. Methods Prospective observational study on 120 patients between the age group of 5 and 12 years. All eligible enrolled cases underwent total leukocyte count (TLC), plasma FB, C reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), absolute neutrophil count (ANC), and erythrocyte sedimentation rate on admission along with pediatric appendicitis score. Final confirmation of diagnosis and allotment of cohort was made by intra operative findings and histopathological confirmation. Two groups were defined: (1) Histopathologically confirmed acute appendicitis-Cases (2) Nonspecific abdominal pain-Controls. Laboratory results were statistically analyzed between the case and the control groups for diagnostic accuracy. Results Study reflected strong statistical significance in terms of leukocyte count, ANC, NLR, CRP, and FB levels. However, plasma FB (value above 4.02 g/L) had the highest diagnostic accuracy rate of 82.50% compared to other laboratory values (TLC-70.83%, CRP-70.00%). Conclusion Plasma FB has emerged as an accurate diagnostic tool and its diagnostic accuracy is superior to all other laboratory parameter studied (TLC, CRP, NLR, and ANC). Plasma FB values above 4.02 g/L is an independent predictor of appendicitis and can help in reducing negative laparotomy in pediatric age group.
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Affiliation(s)
- M S Vinod Kumar
- Department of Surgery, Command Hospital (EC), Kolkata, West Bengal, India
| | - Mannu Kumar Tiwari
- Department of Surgery, Command Hospital (EC), Kolkata, West Bengal, India
| | - Jasdeep Singh
- Department of Pathology, Command Hospital (EC), Kolkata, West Bengal, India
| | - Anil Malik
- Department of Surgery, Command Hospital (EC), Kolkata, West Bengal, India
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Morandi A, Cipriani E, Parolini F, Consonni D, Calderini E, Franzini S, Leva E. The coagulation profile as a marker for acute appendicitis in the paediatric population: Retrospective study. Afr J Paediatr Surg 2020; 17:59-63. [PMID: 33342835 PMCID: PMC8051619 DOI: 10.4103/ajps.ajps_52_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Appendicitis is the commonest and most frequently misdiagnosed acute abdominal surgical illness in the paediatric population worldwide. The aim of this study is to evaluate the role of coagulation profile in acute appendicitis (AA) in children. MATERIALS AND METHODS we retrospectively collected data of patients submitted to appendectomy from 2011 to 2017. According to histopathology, patients were divided into three groups: not histologically confirmed AA (NAA), simple AA (SAA) and complicated AA (CAA). White blood cell (WBC) count, relative neutrophilia (Neutr%), C-reactive protein (CRP), prothrombin time ratio (PTratio), activated partial thromboplastin time ratio (APTTratio) and fibrinogen (Fib) were compared among groups. RESULTS Three hundred and seven patients were included: 57 NAA, 184 SAA and 66 CAA. WBC was significantly different among groups: CAA (mean 16.67 × 103/ml), SAA (14.73 × 103/ml, P= 0.01) and NAA (10.85 × 103/ml, P< 0.0001). Significant differences were found for Neutr% (mean CAA 81.14 vs. SAA 77.03 P= 0.006, vs. NAA 63.86 P< 0.0001) and CRP (mean NAA 2.56, SAA 3.26, CAA 11.58, P< 0.0001). PTratio and Fib increased with the severity of AA receiver operator characteristic curves were similar for CRP (0.739), Fib (0.726), WBC (0.746) and Neutr% (0.754), while for PTratio and aPTTratio were 0.634 and 0.441, respectively. CONCLUSIONS extrinsic coagulation pathway is altered in AA, especially in CAA. Coagulation can be useful in the diagnostic and perioperative anaesthetic management of AA in children. Fib seems to have the highest accuracy.
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Affiliation(s)
- Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Filippo Parolini
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Dario Consonni
- Department of Epidemiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Calderini
- Department of Anesthesia and Pediatric Intensive Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Franzini
- Department of Anesthesia and Pediatric Intensive Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pediatric Anaestesia and Intensive Care, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan; Università Degli Studi of Milan, Italy
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Boettcher M, Günther P, Breil T. The Heidelberg Appendicitis Score Predicts Perforated Appendicitis in Children. Clin Pediatr (Phila) 2017; 56:1115-1119. [PMID: 27872360 DOI: 10.1177/0009922816678976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In the future, surgical management of pediatric appendicitis might become limited to nonperforating appendicitis. Thus, it becomes increasingly important to differentiate advanced from simple appendicitis and to predict perforated appendicitis among a group of children with right-sided abdominal pain, which was the aim of this study. METHODS An institutionally approved, single-center retrospective analysis of all patients with appendectomy from January 2009 to December 2010 was conducted. All diagnostic aspects were evaluated to identify predictors and differentiators of perforated appendicitis. RESULTS In 2 years, 157 children suffered from appendicitis. Perforation occurred in 47 (29.9%) of the patients. C-reactive protein (CRP) levels higher than 20 mg/dL ( P = .037) and free abdominal fluid on ultrasonography ( P = .031) are the most important features to differentiate perforated from simple appendicitis. Moreover, all children with perforation had a positive Heidelberg Appendicitis Score (HAS). A negative HAS excludes perforation in all cases (negative predictive value = 100%). DISCUSSION Perforated appendicitis can be ruled out by the HAS. In a cohort with right-sided abdominal pain, perforation should be considered in children with high CRP levels and free fluids or abscess formation on ultrasound.
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Prada-Arias M, Vázquez JL, Salgado-Barreira Á, Gómez-Veiras J, Montero-Sánchez M, Fernández-Lorenzo JR. Diagnostic accuracy of fibrinogen to differentiate appendicitis from nonspecific abdominal pain in children. Am J Emerg Med 2017; 35:66-70. [PMID: 27760719 DOI: 10.1016/j.ajem.2016.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/07/2016] [Accepted: 10/03/2016] [Indexed: 12/29/2022] Open
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Nyuwi KT, Singh CG, Khumukcham S, Rangaswamy R, Ezung YS, Chittvolu SR, Sharma AB, Singh HM. The Role of Serum Fibrinogen Level in the Diagnosis of Acute Appendicitis. J Clin Diagn Res 2017; 11:PC13-PC15. [PMID: 28274001 DOI: 10.7860/jcdr/2017/21479.9319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/20/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Acute appendicitis is the most common indication for emergent surgery and affects a wide range of patients at any age group. However, inspite of the presence of various imaging modalities, biochemical markers, and scoring systems the negative appendectomy rate remain high. Serum fibrinogen, an acute inflammatory mediator is usually raised in any acute inflammatory condition and the same is expected to rise in acute appendicitis, which may be used as a new inflammatory marker in the diagnosis and more importantly in decision making of management of acute appendicitis. AIM To determine the relationship between the rise in the level of serum fibrinogen and acute appendicitis and its role in reducing the negative appendectomy rate. MATERIALS AND METHODS A total of 82 patients with clinical signs and symptoms of acute appendicitis who underwent emergency appendectomy were included in the study, the serum fibrinogen level were measured just before the operation and the sensitivity and the specificity was calculated. The final diagnosis was based on the histopathological examination. RESULTS In our study, the Mean±SD of serum fibrinogen in mg/dl in those patient proved to be having acute appendicitis by histopathology was 436.6±40.6 while those with normal appendix was 391.91±66.54. The area under the curve was 0.697 i.e., it has an accuracy of around 70% and this is statistically significant (p=0.018). On further sub-analysis when the cut off level of fibrinogen level was reduced to 397, it resulted in a sensitivity of 82% and specificity of 60% and if the level was further reduced to 375 it increased the sensitivity to 88% with a specificity of 55%. CONCLUSION In the diagnosis of acute appendicitis, use of fibrinogen blood level may be a new diagnostic acute-phase reactant with possible role in reducing negative appendectomy rate.
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Affiliation(s)
- Kuotho T Nyuwi
- Junior Resident, Department of General Surgery, Regional Institute of Medical Sciences , Imphal West, Manipur, India
| | - Ch Gyan Singh
- Assistant professor, Department of General Surgery, Regional Institute of Medical Sciences , Imphal West, Manipur, India
| | - Sridartha Khumukcham
- Senior Resident, Department of General Surgery, Regional Institute of Medical Sciences , Imphal West, Manipur, India
| | - Raju Rangaswamy
- Junior Resident, Department of General Surgery, Regional Institute of Medical Sciences , Imphal West, Manipur, India
| | - Yibenthung S Ezung
- Junior Resident, Department of General Surgery, Regional Institute of Medical Sciences , Imphal West, Manipur, India
| | - Sowdin Reddy Chittvolu
- Junior Resident, Department of General Surgery, Regional Institute of Medical Sciences , Imphal West, Manipur, India
| | - A Barindra Sharma
- Professor, Department of Department of Immunohaematology and Blood Transfusion, Regional Institute of Medical Sciences , Imphal West, Manipur, India
| | - H Manihar Singh
- Professor, Department of General Surgery, Regional Institute of Medical Sciences , Imphal West, Manipur, India
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13
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Zhao L, Feng S, Huang S, Tong Y, Chen Z, Wu P, Lai XH, Chen X. Diagnostic value of hyperfibrinogenemia as a predictive factor for appendiceal perforation in acute appendicitis. ANZ J Surg 2015; 87:372-375. [PMID: 26362339 DOI: 10.1111/ans.13316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Lingling Zhao
- Department of Pathology; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Shaoguang Feng
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Department of Pediatric Surgery; Hangzhou Children's Hospital; Hangzhou China
| | - Songsong Huang
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Yulong Tong
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Zhongliang Chen
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Peng Wu
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Department of Pediatric Surgery; Northwest Women and Children's Hospital; Xi'an China
| | - Xin-He Lai
- Institute of Inflammation and Diseases; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Institute of Translational Medicine; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Xiaoming Chen
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Institute of Inflammation and Diseases; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Institute of Translational Medicine; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
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